New access for radiofrequency catheter ablation of left-sided atrioventricular accessory pathways: safety and efficacy of the transradial approach

TransRadial versus transUlnar artery approach for elective invasive percutaneous coronary interventions: a randomized trial on the feasibility and safety with ultrasonographic outcome - RAUL study

Introduction

Transradial access (TRA) for coronary angiography (CAG) and percutaneous coronary intervention (PCI) is superior to transfemoral access (TFA). Transulnar access (TUA) is an alternative to TRA.

Aim

To compare the efficacy and safety of TRA vs. TUA in patients scheduled for CAG or PCI.

Material and methods

This was a prospective, single-center, randomized study conducted between 2013 and 2016. Two hundred patients referred for the first elective CAG were included in the study. Eligible patients were then randomly assigned to the TRA or TUA group. Before and after the invasive procedure, all patients underwent ultrasonographic measurements of the right upper limb arteries.

Results

The primary endpoint was efficacy, defined as a successful CAG without a crossover of vascular access. The secondary endpoint was safety, assessed as the number of vascular complications. Successful coronary angiography via the access site was 95% vs. 75% in the TRA vs. TUA groups, respectively (p < 0.001). It depended on the anatomy of UA and the operator experience. No differences were observed in early and late follow-up complications.

Conclusions

TRA was superior to TUA with regard to efficacy. TUA occurred a safe approach for CAG and PCI and could be used as an alternative method of forearm access.

The case of successful catheter ablation using only the approach from the upper part of the subject's body, with meandering aorta and implanted IVC filter

A 79-year-old female had paroxysmal supraventricular tachycardia. However, she was implanted with an inferior vena cava filter and her descending aorta had significant meandering. It was thought that the insertion of the catheters would be difficult from the femoral vessels. Therefore we inserted electrode catheters from the right subclavian vein and internal jugular vein. As a result of an electrophysiology study, we diagnosed atrioventricular reciprocating tachycardia with a left lateral concealed accessory pathway (AP). An ablation catheter was introduced retrogradely through the left brachial artery and it was pushed forward under the mitral valve. Furthermore, it was put into the part where the earliest retrograde atrial deflection was recorded under the right ventricular apex pacing, and we succeeded in ablation of the AP. All catheters were inserted only from the upper part of the person's body. As for catheter operability, electric potential, operation time, and fluoroscopy time, there was no change in the case of either approach from the femoral vessels. Because we did not puncture the inguinal region, the patient was able to return to her ward on foot after the operation. In addition, we were able to perform a radical cure without complications.

Transradial catheter ablation of left accessory pathway in patient with severe chest deformity

A 45-year-old woman with severe chest deformity and great vessel tortuosity successfully underwent left accessory pathway ablation of atrioventricular reentrant tachycardia via right transradial arterial access. Transradial catheter ablation of left accessory pathway was safe and efficacious without complications. When transfemoral or transseptal access was impossible, transradial access was a good alternative route.

Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures

BACKGROUND

In recent years, the radial artery (RA) has become an alternative vascular access site for percutaneous coronary procedures, and the ulnar artery (UA) is another possibility. The objective of this study was to investigate the anatomy of the forearm arteries with ultrasound (US) and to evaluate the effect of the anatomy of the right RA (RRA) on the outcomes of transradial coronary procedures.

METHODS AND RESULTS

The 638 patients undergoing transradial coronary procedures were examined with US for measurement of the diameters of the forearm arteries and determination of their anatomical abnormalities before the procedures. The next day the incidence of RA occlusion was recorded. The diameters of the radial and ulnar arteries were similar (P>0.05). The procedure time was longer in patients with anatomical abnormalities (P<0.05) and whose RRA had a diameter <2 mm (P<0.05). The incidence of procedure failure, and of RA occlusion one day after the procedure was also higher in patients with an anatomical abnormality of the RRA (P<0.01 and P<0.05, respectively) and whose RRA diameter was <2 mm (P<0.05 and P<0.05, respectively).

CONCLUSIONS

The diameters of the forearm arteries of Chinese people are similar. The small diameter and anatomical abnormalities of the RRA could result in longer procedure time, more incidence of procedure failure and RA occlusion.